Is Weight Loss Ever the Right Prescription for BED?

Amy Pershing, LMSW, ACSW

Recovery from binge eating disorder (BED) is a long haul. The ride is bumpy, frightening, rewarding, and ultimately incomplete, just like all human healing. As a psychotherapist, I have treated BED for over 30 years. I have worked with literally thousands of people who have tried to understand their binge behaviors, and to find some kind of peace with food and the body in which they live. While people at any size can have BED, for those with the disorder who live in bigger bodies, "successful" recovery is often assumed to include weight loss. The inner story, often supported in treatment, sounds something like this: "I am fat (which is intrinsically bad and unhealthy) because I binge. I binge because I have no willpower and low self-esteem. I have to fix my distorted thinking about myself, eat "reasonably," and my weight will change. Then I will be healthy/happy/recovered." Ultimately, the implication is that weight is a matter of self-control, that "thinner" is intrinsically both possible and healthier, and that recovery will enable us to fix the situation. Tragically, this approach actually blames the victim, ignores the enormous role of weight stigma and thin privilege in the development of the disorder, and disempowers people from learning they can trust their bodies no matter their weight.

As research continues to show, behavioral weight loss results in weight gain almost all the time over the long term. Our bodies do not distinguish between a diet and a famine, and they react accordingly by holding onto weight and driving desire for highly palatable foods that convert quickly to energy. This is not willpower failure; it is our body saving our lives. We are also learning that weight and health do not have the direct causal relationship we have been led to believe. In fact, the data tell us we cannot determine how weight impacts health in any given person. It just isn't that simple. Fat people have healthy hearts and sick hearts. So do thin people. Even in cases where weight may be a causal factor in health concerns, dieting/food restriction is still not an effective "treatment" because it does not result in long term weight loss. As the Health at Every Size® paradigm reminds us, healthy bodies come in all shapes and sizes. By eating and moving with awareness, permission, and attunement, our body alone knows what weight is best. No matter what, the best approach to improved health is still one of paying attention to needs and cherishing our bodies as best we can.

People struggling with BED also have higher rates of trauma in their lives than found with other eating disorders. Childhood abuse or neglect patterns fuel shame that can be so pervasive it is as if shame is the person's very identity. Internalized weight stigma is a place shame can cling, with an entire culture fueling the fire. Many people in bigger bodies learn that weight loss is more important than their very physical, psychological, and spiritual wellbeing. As many as 65% of people with eating disorders say weight-related bullying (which is traumatic for most) contributed to the development of their binge eating. Up to 60% report some other childhood trauma as well. Imagine the damage done when these experiences interact. Making weight loss a recovery goal (instead of body attunement and protection) reinforces these shame filled narratives.

Allowing our bodies to find their own way with regard to weight is, at this point in our world, a political act. Challenging the notion of a body ideal promotes body diversity and inclusivity, and supports people living in integrity with body wisdom. It also holds systems that promote thin privilege and weight bias accountable; instead of changing our weight, we need to change the systems of shame around us. If you are in recovery from BED (or any eating disorder), learn about Health at Every Size®, find community that can support you, and honor that binge eating is never a question of willpower or weakness. Quite to the contrary, learning to care for our bodies as our homes, not billboards, is perhaps the bravest thing we can do.

Amy Pershing is the Clinical Director at the Center for Eating Disorders and the Founding Director of Bodywise™, a comprehensive treatment for binge eating disorder. Amy lectures internationally on the treatment of BED and her own recovery. She is past chair of the Binge Eating Disorder Association and co-author of Binge Eating Disorder: The Journey to Recovery and Beyond (Routledge, 2018).